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ARE GREAT MEDICAL LEADERS BORN OR MADE? THE MAGAZINE FOR JUNIOR DOCTORS
Presenting History JuniorDr is a free lifestyle magazine aimed at trainee doctors from their first day at medical school, through their sleepless foundation years and tough specialist training until they become a consultant. It’s proudly produced entirely by junior doctors - right down to every last spelling mistake. Find us quarterly in hospitals throughout the UK and updated daily at JuniorDr.com. Editor Ashley McKimm, editor@juniordr.com Editorial Team Michelle Connolly, Anita Sharma, Muhunthan Thillai, Andro Monzon Newsdesk news@juniordr.com Advertising & Production Rob Peterson, ads@juniordr.com JuniorDr PO Box 36434, London, EC1M 6WA Tel - +44 (0) 20 7 684 2343 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, Gordon Brown (if he is still PM by date of publication), his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong. It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2009. All rights reserved. Get involved We’re always looking for keen junior doctors to join the team. Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones). Check out JuniorDr.com.
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hile philosophers argue whether a great leader is simply born or can be made, the NHS is hedging its bets. After 60 years helping give birth to medical leaders it has decided to have a go at making some too. It’s true that up until recently doctors neither wanted to be born or made a leader. That was left to the dark realm of hospital bureaucrats who created policies that seemed to make our jobs harder. That is about to change. 2009 is the year that doctors are finally being encouraged to take the reins of our National Health Service. A massive push is underway from a host of organisations to give doctors the leadership and management skills to drive the NHS forward. Among the ambitious aims is to have at least one doctor applying for every chief executive post in the UK. In the United States you’ll find that many hospital CEOs have a clinical background - and also a MBA to their name. It makes sense. Get the people who understand patient care the most to run hospitals. This issue we look at what makes a great leader and why you should become one. Dr Andrew Vallance-Owen, Medical Director of BUPA, shows us that being a medical leader doesn’t necessarily confine you to the basement of an NHS Trust (page 12). We chart his route from medical student to director of the UK’s leading private insurer. We take a look at MBAs, Leadership MScs and offer some advice on how to start moving up that leadership ladder (page 9). If you don’t develop leadership skills as a junior doctor we discover that it might be too late. Be reassured. Becoming a medical leader isn’t about abandoning your clinical practice. Each day we all make management decisions about the care of our patients. Gaining these new skills is about improving that. The NHS is calling out for medical leaders in 2009. It’s your chance to prove that great medical leaders can be made as well as born. Read our guide and get involved.
“After 60 years helping give birth to medical leaders the NHS has decided to have a go at making some too.”
Ashley McKimm JuniorDr Editor-in-Chief ST2 Psychiatry
What’s inside 04 09 14 15 16
LATEST NEWS Making future Medical Leaders
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EWTD
URGENT ACTION NEEDED TO AVOID ‘DISASTER’ THIS AUGUST
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atients ‘may die’ if surgery is not exempt from the European Working Time Directive, the Royal College of Surgeons has warned. It also believes the effect on training will be disastrous. With less than 60 days until the 48 hour working week comes into effect on August 1st the latest data shows that the number of rotas reporting compliance with the EWTD actually fell from 78% in March to 72% in April. The Royal College of Surgeons is calling for urgent action by the Department of Health to avoid ‘disaster’ this August: “The EWTD is unworkable, dangerous for patients and disastrous for training. This battle is for the soul of surgery, and must and will be won,” said John Black, President of the Royal College of Surgeons.
John Black President of the Royal College of Surgeons
“This battle is for the soul of surgery, and must and will be won. Patients will ultimately suffer and some may even die if it is not.” “Patients will ultimately suffer and some may even die if it is not. I do not know when, but sooner or later this government or its successor will have to exempt surgery, and I suspect many other specialties too.” EWTD compliance currently varies across the UK. A survey by the DHSSPS Implementation Support Group, responsible for EWTD implementation, found that Northern Ireland had the lowest rota compliancy with just 40% meeting the 2009 limits. 4
NEWS PULSE
In Scotland only 57% of junior doctors are working an average of 48 hours a week.
Losing half a million hours The situation will be exacerbated by the 3000 doctors’ posts that are currently unfilled, says the Royal College of Surgeons. It points out that there are not enough doctors in the UK to staff the NHS under working time restrictions and attempts to recruit doctors from around the world are failing: “Moving to 48 hour working with current staffing means losing half a million hours of doctor-patient time a year from the NHS and the NHS is struggling to cope,” said Black. “The College reported in January that rotas were only being held together by internal locums and were meeting the European regulations on paper alone. It is now becoming apparent the closer we get to the deadline that the Governments predictions on meeting this regulation have been hopelessly optimistic.” It expects the number of clinical rotas that report compliance to fall further as the August deadline approaches. It warns that some Trusts are being tempted to introduce dangerous working practices to meet the demands.
‘Speak out’ to support training The Royal College of Surgeons concerns about training have been echoed by Andy Thornley, Chairman of the BMA’s Junior Doctors Committee. He has called on doctors to make their fears about training known: “We are worried that opportunities for trainees to find the time to learn new
procedures will be lost in the rush to deliver services to patients,” he said. “Junior doctors must raise their concerns if they feel their training or the safety of patients is being adversely affected. We owe it to patients and future generations of doctors to speak out on this issue.”
Alan Johnson Health Secretary
“There is no evidence that greater numbers of trainees are failing their end of year assessments where 48 hour working has been introduced.” Health Secretary Alan Johnson, despite launching a review into the effect of the EWTD in May, failed to acknowledge it put patients at risk: “There is no evidence that greater numbers of trainees are failing their end of year assessments where 48 hour working has been introduced.” The BMA has called for short-term practical solutions to be considered, including the re-introduction of training lists to ensure that trainees assist with procedures which are suitable for their stage of training. It also called for investment in simulators and skills labs to enable doctors to practise techniques using technology which simulates an operation. www.bma.org.uk www.rcseng.ac.uk www.dh.gov.uk
PMETB to merge with GMC Draft legislation for the merger of the PMETB and GMC has been published by the Department of Health. If successfully approved by parliament the functions of PMETB will transfer to the GMC in April 2010. The joint body will be responsible for regulating all stages of medical education from entry to medical school until retirement from practice. www.gmc-uk.org
Military docs wounded by payrise Military doctors and dentists are to receive a 1.5% pay rise this year, significantly lower than the 2.8% awarded to other armed forces personnel. The BMA has warned this is likely to adversely affect recruitment and retention of armed forces doctors - especially the MOD’s plan to double the number of psychiatrists and anaesthetists. www.mod.uk
training
Immigration changes will ‘deprive UK of doctors’
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verseas medical students studying in the UK could be forced home after their FY2 year putting doctor recruitment under further strain, the BMA has warned. Requirements for Tier 1 immigration in the UK changed in April meaning that doctors now need the minimum of a Master’s degree to be accepted. A medical degree is currently classified as a Bachelor’s degree which could result
Dr Hamish Meldrum BMA Chairman
“Restricting their career options to such an extent represents a huge waste of taxpayers’ money and may lead to affected doctors leaving the UK permanently.”
in many medical students and junior doctors being forced to leave the country. Dr Hamish Meldrum, Chairman of BMA Council, called on the Secretary of State for Health to intervene: “The full implementation of the European Working Time Directive and its impact on junior doctors’ training hours, coupled with a situation in which a proportion of prospective trainees can no longer continue with their training due to ever-tightening immigration rules, is likely to exacerbate rota gaps, putting patient safety at greater risk,” he said. “Restricting their career options to such an extent represents a huge waste of taxpayers’ money and may lead to affected doctors leaving the UK permanently.” Tier 1 replaced the previous HSMP in February 2008 and meant that some doctors were restricted from working. It also led to a sharp reduction in the numbers of overseas doctors coming to the UK - as a result trusts are finding it harder to find locum doctors to fill rota gaps. www.bma.org.uk
Simulating surgery Virtual reality simulators can help surgeons improve performance and reduce operating time, according to research published in the BMJ. The randomised controlled trial carried out in Demark found the performance of novices was increased to the level of intermediately experienced laparoscopists whilst the operation time was reduced by half. www.bmj.com
Shaken not stirred Regularly drinking three units of alcohol a day can double the likelihood of developing essential tremor, according to the Journal of Neurology, Neurosurgery and Psychiatry. The study of 3,300 people in Spain took account of confounders, such as lifetime cigarette smoking and depression. Involuntary tremor is believed to result from the toxic effects of alcohol to the cerebellum. jnnp.bmj.com
Working Conditions
‘No way to pay’ for reduction in US junior doctor hours $1.6
billion would be needed to reduce the hours of medical residents in the USA to an average of 80 hours per week, according to a study published in the New England Journal of Medicine. The research follows a major new report from the Institute of Medicine which includes calls to reduce from 30 to 16 hours the time residents can work without sleep. Despite studies showing that serious medical errors could be cut by as much as 25 percent in medical intensive care units, experts say it is currently unaffordable: “Adopting new restrictions on the work hours of physicians in training would impose a substantial new cost on the nation’s 8,500
physician training programs,” said lead author Dr Teryl Nuckols, at the David Geffen School of Medicine at UCLA. “There is no obvious way to pay for these changes so that’s one major issue that must be addressed.” Currently graduate medical education programs require residents to work long hours, often more than 100 hours per week. Recommendations from the IOM include reducing overall hours to 80 per week, that prolonged shifts should include protected time for sleep and increasing the number of days residents must have off. content.nejm.org
NEWS PULSE
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Broken bones and finances
NHS
MOST DOCS REMAIN COMMITTED TO NHS AFTER 25 YEARS
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our out of five doctors continue to work in the NHS 25 years after qualification, according to a study published in the BMJ. The study tracked 32,013 graduates from medical school and found that 88% continued to work in the NHS two years after qualification. This dropped slightly to 81% after 25 year follow-up. The data appears to refute claims that increasingly disenchanted doctors are leaving the NHS. In addition, it found that most of the doctors who had moved outside of the NHS continued to work in medicine, either in the private sectors or overseas. A second study of 7,012 doctors looked at
career progression of men and women in the NHS. It found that although a smaller proportion of women than men progressed to senior posts, and that men progressed more quickly than women to these posts, the career paths of women who had always worked full-time were very similar to those of men. The authors say that, although this data indicates that there is no systematic direct discrimination against women in the NHS, indirect discrimination may remain and might include factors like working conditions that conflict with family life and lack of suitable role models in some specialties. www.bmj.com
nhs
WOMEN TO BECOME MAJORITY OF DOCS AFTER 2017
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emale doctors will outnumber their male counterparts in as little as eight years, according to a two-year review by the Royal College of Physicians. It warns that the increasing proportion of female doctors could become a major issue for the health service as women are more likely to work parttime and focus on particular specialties. Women currently make up 40% of all doctors but account for only 28% of consultants. Only 8.4% of consultant surgeons are women. “This research has shown that women doctors will soon be in the majority and are now reaching consultant status in greater numbers. It is likely to lead to an increase in part time working. Also, women on average make different specialty choices from men,” said Professor Jane Dacre, Chair of the RCP Working Group. 15 years after graduating the study found that on average, taking into account career
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NEWS PULSE
60 percent of all US bankruptcies are attributable to medical problems, according to new research due to be published in the American Journal of Medicine. The study, which took place before the current economic downturn, found that an American family filed for bankruptcy in the aftermath of illness every 90 seconds. For 92% of these high medical bills directly contributed to their bankruptcy. www.amjmed.com
Holiday over for overseas ops Sending patients overseas for operations may be putting them at risk as well as costing the taxpayer more money, according to research published in the Annals of the Royal College of Surgeons. The study matched two cohorts of 22 patients undergoing arthroplasties - one in the UK and the other in Belgium. Once the increased probability of complications was accounted for the average treatment cost for the Belgium patients was £180,000, compared with £156,500 for the local group. www.rcseng.ac.uk
MRSA goes private As many as one in four nursing home residents carry the MRSA bacteria, according to research by Queen’s University Belfast. The study, thought to be the largest of its kind studying MRSA in private nursing homes, found that 24% of the 1,111 residents were found be colonised by the bug. Up to 28% of staff also tested positive. www.qub.ac.uk
breaks and part-time working, women provide 60% of a full time equivalent doctor, against 80% for men. The highest proportion of female consultants currently work in GP, Paediatrics and Public Health specialities. The authors noted that these preference rankings are not just a UK phenomenon but are closely matched internationally. www.rcplondon.ac.uk
Give tea time to cool Drinking very hot tea can increase the risk of throat cancer, according to a new study published in the BMJ. The study of 871 participants found that compared with drinking warm or lukewarm tea (65°C or less), drinking very hot tea (70°C or more) was associated with eight-fold increased risk. www.bmj.com
NHS
DOCTORS SWIPE CARDS POSE SUPERBUG RISK
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octors’ swipe cards are a potential source of hospital-acquired infections, including MRSA, according to research published in the Annals of the Royal College of Surgeons of England. The study, which was the first to look at the contamination of swipe cards, found that 21% of those carried by doctors were contaminated with pathogenic bacteria, including MRSA. Out of the 39 cards sampled those kept in a wallet or the doctor’s pocket were the most contaminated. Only one-third of the cards were carried this way but accounted for two-thirds of all pathogenic bacteria. “Security swipe cards and scanners are contaminated with, and may therefore act as a reservoir for, pathogenic bacteria implicated in hospital-acquired infection,” says Robert Greatorex, senior author of the study at the Queen Elizabeth Hospital in King’s Lynn. “Regular cleaning of cards and scanners with alcohol removes all bacteria and would be a simple method of removing this potential source of hospital-acquired infection.” An accompanying questionnaire found that only a minority of doctors cleaned their cards, despite knowledge that wiping with alcohol removed all bacteria from swipe cards and card scanners.
www.rcseng.ac.uk/publications/annals
NHS
DRUG REP FREEBIES INFLUENCE MED students
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mall promotional products from drug companies, such as pens and notepads, influence medical students’ attitudes towards pharmaceutical drugs, according to a study published in the Archives of Internal Medicine. The randomised controlled study of 352 third and fourth-year medical students primed half the students by exposure to small branded promotional items for the cholesterol-lowering medication Lipitor, including a clipboard and notepad used when they signed in to study appointments. The test involved matching the brands to attributes - such as pleasant and unpleasant - and reporting their explicit attitudes toward both drugs by completing a questionnaire about safety, superiority, efficacy and convenience. Those exposed to the marketing demonstrated stronger preferences toward Lipitor after exposure to promotional items, whereas the controlled medical school exhibited the opposite response. “Our results provide evidence that subtle branding exposures are important and influential, as the psychology and marketing literature would suggest,” concluded the team at University of Pennsylvania, Philadelphia.
archinte.ama-assn.org
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Wellcome Collection
EXQUISITE BODIES
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uring the 19th century, museums of anatomical models became popular attractions for Europeans seeking an unusual afternoonâ&#x20AC;&#x2122;s entertainment. In London, Paris, Brussels and Barcelona the public could learn about the inner workings of the body through displays that combined serious science with an element of fairground horror. Exquisite Bodies at the Wellcome Collection will reveal how spectacular collections of anatomical models were used not only to teach but also to titillate the public in Victorian Britain and Europe. The collection runs between the 30th July and 18th October 2009. For more information visit:
www.wellcomecollection.org
Dissection of the Head and Neck Joseph Towne c. 1827-79 (Courtesy of the Gordon Museum, Kings College London)
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Profile: BUPA Medical Director Andrew Vallance-Owen
For a company whose mission statement is to help people “live longer, healthier, happier lives” Andrew Vallance-Owen certainly lives that message. He’s a man on his 13th BUPA Great North Run and medical director of the UK’s largest private healthcare company with over 10 million customers around the world.
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s the medical face of BUPA his primary job is to be responsible for the safety and quality of care but he also represents the group when a medical background is needed. This can be on diverse matters such as discussing how BUPA could assist with a UK swine flu epidemic to a government meeting at No. 10 to influence health policy. Andrew is also a key player in the group’s expansion into emerging markets. In the last few weeks he has been to China, Australia and the Middle East. “There is a lot of international travel which although it sounds exciting can be very tiring,” says Andrew. “The timetable is hectic but I find it fascinating to be working in so many different markets.” It’s the variety of his job that leaves Andrew with no regrets twenty-three years after leaving his clinical career. “I used to love surgery but I’ve thrown off those shackles,” he says. “The best bit about being medical director is never knowing what is going to happen next.”
Medical student to medical director Andrew’s passion for leadership first developed soon after he joined Birmingham medical school back in 1970. He started by running the generic ‘wine and cheese evenings’ as president of the medical society but soon found himself voted in as student president opposing a 30 percent rise in hall fees in a fight that reached the national press. The following year he was running for president of the NUS in a battle against now well known political candidates like Charles Clarke. He lost - but his thirst for politics continued. Andrew joined the BMA’s junior doctor committee and became deeply involved in medical politics. Just prior to becoming a SpR the opportunity arose of a staff post in 10
the BMA. He left clinical practice, took the post and quickly moved up the ranks becoming Scottish Secretary before taking up the post of head of BMA policy in London. After picking up management skills as well as an MBA whilst at the BMA he was approached by BUPA in 1994 who were looking for a new medical director for its BUPA Hospitals division. Describing himself as an ‘NHS person through and through’ Andrew was reluctant: “I’d been a garlic cross person in terms of my attitude to the whole private sector just like many junior doctors,” he said. “But I was greeted by a young, enthusiastic BUPA team with a clear vision. I found that inspiring.”
“I loved surgery. Being out of the operating theatre was tough for the first two years but since then I have never looked back.” Just one year into the post he was offered the position of medical director of the entire BUPA group. He accepted, and has been the medical face of BUPA ever since.
Advising future leaders Making the transition from a clinical role to management wasn’t an easy one says Andrew: “I loved surgery. Being out of the operating theatre was tough for the first two years but since then I have never looked back.” At that time there were no options of part-time training or secondments to gain management experience. Andrew had to make the jump from full-time surgeon to full-time BMA staffer in one go - a huge career shift even for someone who had been as involved in medical politics as he was.
FUTURE MEDICAL LEADERS
Today he encourages anyone keen on following his footsteps to take advantage of the opportunities that are available to junior doctors, such as the CMO Clinical Advisor Scheme. Andrew has recently been interviewing candidates to join Bupa as part of this year’s programme and says he was surprised at the level of leadership and entrepreneurism among junior doctors. Successful applicants will have the option of shadowing Andrew in his post at BUPA.
The future for BUPA Andrew sees an exciting future for BUPA, particularly overseas. He highlights the opportunities of the group’s entry into China but recognises that this will be accompanied by some real challenges. “I am a passionate believer in evidence based medicine and clinical governance but just transferring UK clinical governance policy into China is not realistic. It would not be understood and you couldn’t deliver it, but we are making a start,” he says. He feels that this demonstrates one of the struggles for any doctor who makes the transition into a leadership role - achieving the balance between business and health service delivery. Andrew says he is fortunate that his colleagues at BUPA recognise the importance of the clinical input from his team: “Putting the customer first is absolutely fundamental to BUPA and that means providing the best quality care.” He finds the opportunities that China presents exciting and he doesn’t seem too daunted by the challenges - for someone who will be training at 6am tomorrow for his next BUPA Great Run it’s something he takes in his stride. With that attitude taking the “live longer, healthier, happier lives” message to the world shouldn’t be a problem for Andrew Vallance-Owen.
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In association with
NICE MAKES BEST EVIDENCE SEARCHABLE
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ICE has launched a new free search engine to help doctors find the “most reliable and trustworthy” clinical information on the internet. NHS Evidence aims to help users find the best evidence for treatment pathways, data on prescribing and public health policies. It was developed in response to Lord Darzi’s ‘High Quality Care for All’ report last June and will be available to the public as well as health professionals. Listed material will be assessed by an independent advisory committee to ensure it has been developed using rigorous processes. The site will also award an accreditation mark to the most reliable and trustworthy sources of guidance.
Dermatology Websites
DermLectures www.dermlectures.com
Ambitiously aiming for 300 free video lectures, DermLectures covers the major topics such as viral infections, acneiform eruptions and bullous disease. Great for learning the basics.
Virtual Grand Rounds in Dermatology www.vgrd.org
Read a new case presentation with macroscopic and microscopic images every few weeks, plus your opportunity to join in the discussion online. Highly recommended to keep those dermatology brain cells working.
eMedicine emedicine.medscape.com/dermatology
From the consistently impressive eMedicine team the dermatology section offers one of the best peer-reviewed resources on the net. Make it one of your first stops. “This is just the first stage in the development of an impartial service which will provide the most comprehensive source of relevant and trustworthy information about clinical, non clinical evidence and best practice, at the touch of a button,” said Dr Gillian Leng, chief operating officer for NHS Evidence. “It’s good news that users, including patients, will be able to find the information they need and know that it comes from a credible source - this will ultimately help improve efficiency and ensure all patients receive the best available care.” NHS Evidence will also allow users to browse evidence using ‘topic trees’, upload and share their own content - such as local service models and policies - and to receive alerts about new information. www.evidence.nhs.uk/
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MEDICAL STUDENTS TECHNOLOGY
DermIS www.dermis.net
The largest dermatology database on the net. Initially DermIS started as a image repository but has expanded to include some useful learning modules on diagnosis and treatment of common dermatological conditions.
British Association of Dermatologists’ Clinical Guidelines www.bad.org.uk/site/622/default.aspx
Part of the wider BAD site these clinical guidelines are a particularly useful learning resource but be careful as some are relatively old and need reviewing. For more key websites in Dermatology - try
HOME COMPUTER SYSTEM AIDS DEMENTIA PATIENTS
STUDENTS GIVE PATIENTS A SECOND LIFE
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hird year medical students have been diagnosing patients in Second Life as part of a new pilot programme at Imperial College. The clinic is part of the College’s presence in the virtual world that allows ‘residents’ to interact with each other via avatars. As part of the trial students are given five virtual patients to talk to, examine and diagnose. They are also provided with money for tests like chest x-rays and have to decide which tests to carry out on the patients to reach the right diagnosis. “A shortage of doctors and higher numbers of students mean that there is less time for teaching,” said Senior Learning Technologist Maria ToroTroconis. “Virtual patients, especially in threedimensional format, can be of real value in supporting clinical teaching.” Students are based in a virtual respiratory ward where developers have attempted to re-create the real experience as much as possible - even requiring students to wash their hands before seeing patients. First time users have to create an avatar - a 3D representation of themselves. On visiting Imperial’s virtual hospital students are then welcomed by the Head of Undergraduate Medicine, Professor Jenny Higham. They can also teleport to the ‘students union’ and ‘research centre’, where they can
home computer system to help dementia patients safely manage daily tasks is currently being trialled in Norway. The touch screen device prompts patients to take their medications, reminds them when their carer is arriving and whether it is daytime or nighttime - a particular problem for dementia sufferers. It is aimed at elderly who can still live alone but are suffering from the early effects of memory loss. The MPOWER device allows relatives or carers to check whether the patient is responding and its two-way functionality allows them to interact too, explains project manager Marius Mikalsen: “This is also a system for sharing information. The families of these patients are often anxPatients give feedback on ious about how MPOWER device it is going with their parents, and this allows both them and the home help to enter messages that will be automatically displayed by the system.” MPOWER is part of an EU programme developing new equipment to aid the increasing elderly population. The system which has been trialled in the two Norweigan cities of Trondheim and Grimstad is being developed further to include home sensors and GPS to track patients. www.sintef.no/Projectweb/MPOWER
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Screenshots from Second Life Ward
interact with other users. The pilot is part of a research to find the best e-learning methods for medical training. Initial findings show that while students are generally receptive to working within the learning environment, they have problems with access and need time to feel comfortable interacting with the virtual patients. “Second Life is a reflection of where the Internet is going. The aim is not to replace face-to-face communication, but to enhance the learning experience,” says Maria Toro-Troconis. www.elearningimperial.com
Searching for quality Web resources in medicine? Intute is a free online service guiding you to the best of the Web for education, training and research
www.intute.ac.uk/medicine/ MEDICAL TECHNOLOGY STUDENTS
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Secret Diary of a Cardiology SpR Monday If you’ve been following this column, you’ll realise that I had just made arguably the most important career decision of my life. As I came up to the end of my SPR rotation I had finally been awarded my MD (for some stupid work about neutrophils that got me a few papers but didn’t really advance cardiovascular science). I was on the verge of applying for consultant jobs when Douglas, my boss and mentor at my mammoth teaching hospital, offered me a job - the only female consultant in a team of five men. There was no way I could say no and after a week of soul searching on the French Alps I accepted his offer. Monday morning was a quick ward round and then paperwork in the afternoon. I left early and went home to catch up on a fantastic novel I had been reading about the life of a thief in Barcelona. It made me want to leave rainy London immediately. I didn’t, and instead I curled up on the sofa with a very large glass of Pinot Noir (I had become tired of Merlot) before dragging myself to bed just before midnight.
* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!
Tuesday Clinic this morning was overbooked as usual. One of the consultants called in to say that his daughter was ill so would be in at lunchtime which left me with a couple of useless SHOs (sorry, Core Trainees) and 40 patients to plough through. Most of them were the routine ‘no sex for a month after your heart attack’ and the ‘stop eating pizza or you’ll die’ consultations. We managed to finish just before the diabetes boys had their turn and I grabbed a quick bite from the canteen before an afternoon of echos. I finished the five inpatient requests by three and went over to help the echocardiographers with their work load of outpatients. The word had gotten round that I was to be appointed (or should I say anointed) as the new consultant and people were being extra nice to me. I had decided to return the favour whenever I could - building up a base of trust between colleagues was something I would try and do slightly better than some of my consultant colleagues. I left around six and went home to watch the tennis. A night in with just me, Rafael Nadal and a glass of Pinot.
Wednesday Angio list this morning. I get a round of applause from the cath lab nurses - I think that secretly they all like me (though they never show it) and are happy that I’m going to stay on. I mock shock but actually find the whole thing rather nice. As usual I’m left on my own - after all if I can’t do it now then I’ll never be able to. CCU ward round this afternoon. The lazy core trainee (I call the other one the super-lazy core trainee) has actually managed to chase the troponins from this morning and file them away. I’m impressed until I realise that he discharged another patient who was supposed to stay in for an inpatient angiogram. I give him the look (far better than a dressing down) and he rushes off to call her back in. I finish early and am home by five. A quick change of clothes and head out for a few drinks with some friends. The drinks turn into dancing which in turn leads me to go home with a friend of mine who has just broken up with his girlfriend. We’ve done this before (when he was still going out with her) so it’s not at all awkward but I leave before daybreak to have a shower at home. 14
SECRET DIARY
Thursday A mild hangover that’s quickly suppressed by some codeine that I find on the ward. I’m on-call today and have a twelve hour day shift. This is something I won’t miss. The morning is quiet and by lunchtime we have cleared the board and I spend an hour teaching medical students how to read an ECG. It’s surprising how little some of them know. The evening goes well and the six o’clock ward round is without hitch. I finish the brief handover and am home by ten. There is no more Pinot left and I can’t face a glass of white so I have a ginger beer and crash out.
Friday A quick CCU round this morning and I find myself twiddling my thumbs for the rest of the day. Douglas calls me and suggests we meet for lunch. He asks me how things are going and whether I have any second thoughts about accepting the job. I firmly tell him no, perhaps a little too firmly, and he smiles. Douglas is in his early sixties and an atypical cardiologist. He’s happily married with three grown up children and now has a bunch of grandchildren. He stays here late if a patient is unwell otherwise he spends time with his wife. He does minimal private practice. I’ve often wondered how he’s managed to create such a perfect life. Although my new job represents getting to the very top of my career ladder, I would give it all up in a heartbeat to be a part-time district general cardiologist with a husband, two kids, a dog and a Land Rover with a six rack CD changer, GPS, climate control and heated seats. Douglas smiles at me and I get the sense he knows what I’m thinking. He mentions the prospect of delaying my start by six months. He has a friend in Melbourne who is looking for someone at the end of their training to teach some advanced interventional skills. It would be good for the hospital, he says, for me to come back with some new skills. Would I be interested? I look at him and slowly start to smile.
...
Focus on Finance - in association with Wesleyan Medical Sickness
To Buy or Not to Buy I
f you’re looking to get a step onto the property ladder, Ian Morgan National Sales Manager with Wesleyan Medical Sickness, gives some guidance on a couple of types of mortgage that might provide a good option for you. There are indications that the property market is starting to show some signs of recovery. House prices are still falling but at a less dramatic rate and some commentators are predicting that they could even rise again by the end of the year. The Royal Institute of Chartered Accountants (RICS) reported in their April survey that more potential buyers are entering the market and this is beginning to translate into an increase in sales. However it’s still early days and noone can say with full confidence what the future will bring for the property market. It’s unlikely, however, that we will see a return any time soon to the days of small deposits and large loans. Since the fall-out from the sub-prime mortgage fiasco, lenders are being more responsible in their lending, making sure they take on less risky customers and
properties. If you’re thinking of buying a home you should seriously consider the pros and cons of buying versus renting and then decide which is the best option for you. You might find the security of owning your own home appealing but not have the resources to pull together a reasonable deposit. In this case you could see if you’re eligible for the Government’s HomeBuy initiative designed to help first time buyers get into the housing market. HomeBuy To be eligible to apply for HomeBuy, you need to be both a first time buyer and have less than £60,000 a year coming into your household (so if you plan to live with a partner, your combined income would need to be £60,000 or under). There are a number of different schemes available administered through agents. In essence HomeBuy means that you can get a loan on a property, potentially of up to 50% of the buying price. You will then have to cover the remaining cost through a traditional mortgage using an approved high street lender that supports the scheme. You will have to pay a monthly fee on the loan as well the interest on the mortgage in the usual way. When you sell the property you need to repay the loan but you can choose to repay some or all of the loan sooner. In doing so, you reduce the amount that your HomeBuy agent receives when the property is sold. Offset mortgages If you’re in the lucky position to have
savings then now is a good time to consider moving to an offset mortgage as your cash will work harder for you. In simple terms, this type of mortgage works by placing your savings with the same provider as your mortgage. You won’t get any interest on your savings but you’ll only pay interest on the net amount of your mortgage. So, for example, if you have £150,000 mortgage and £20,000 in savings, you would pay interest on just £130,000 of your mortgage. In the current climate, when interest rates are so low, this offers a good way of maximising the return on your savings. Also as you aren’t charged interest on your savings you won’t have any tax to pay on them. Many people find offset mortgages quite complicated but they do offer a raft of advantages to borrowers. You can make overpayments or underpayments on the mortgage, which can be helpful if your situation changes and you can even take payment holidays. They also lower the total interest paid over the length of the loan and shorten the mortgage term because the interest is charged against a lesser mortgage balance. Finding the best mortgage deal for your long-term needs isn’t an easy job. It takes time and effort to trawl the market. You might want to choose a broker to do the job for you. Make sure you go with an organisation like Wesleyan Medical Sickness, which will compare the whole of the mortgage market and not focus on a limited number of providers. Remember that your home may be repossessed if you do not keep up repayments on your mortgage.
The above information doesn’t constitute financial advice and the suitability of any mortgage depends on your personal circumstances. Wesleyan Medical Sickness provides specialist financial advice for doctors. Telephone 0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk
Specialist financial services for doctors • Savings and Investments
• Mortgages and Insurance
• Retirement Planning
• Personal Loans and Bank Accounts
• Life and Income Protection
0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk 16
FINANCE
Weekend Ward Escape to
Brussels People don’t get excited about Brussels. It lacks the elegance of Paris, the nightlife of Amsterdam and is even overshadowed by the romance of it’s own northern sister Bruges. But that’s exactly why Brussels has it’s charm. No-one expects to like it, in fact many visit already certain they’ll be disappointed, but most leave confounded. If you don’t expect to fall in love with the city at the heart of Europe you might just do so. Where to stay? Hotels in Brussels are nothing to shout about. There are the scores of sterile, functional chains catering for the constant trips of politicians to this EU hub. Amigo is the one exceptional hotel in the city and is priced exceptionally to boot so it tends to be the haunt of top politicians and celebrities. If you’re unable to claim on MP expenses try the centrally located and practical George V (Rue ‘t Kint) or NH Grand Place (Rue D’Assaut) instead. Visitors who are more frugal with their budget should try Bruegel (Rue Du St-Esprit) - a newly refurbished youth hostel situated a few minutes from the main square. You can stay in a double room for just 20 euro a night. There is a 1am curfew - but it has it’s own bar which stays open until the last man is standing.
Eating Belga Queen - (Rue du Fosse aux Loups) A stylish (and moderately expensive) restaurant set in a giant converted bank where you can dine with the Brussels elite. The food is typically Belgian and served by
the weird antics of your fellow travellers.
Nightlife Le Bier Circus (Rue de l’Enseignement) - 200 beers which means there’s just enough time to try them all and turn up sober for the Monday ward round. Intimate and with knowledgeable staff it’s the ideal place to savour the flavour of Belgian beer and get esquisitely drunk.
Day Trips
Brussels - Grand Place
waiters dressed conspicuously like monks. Watch out for the transparent toilet doors that confuse many a tourist. Chez Leon - (Rue des Bouchers) Gracing the backstreets of Brussels for over a century Chez Leon is a cheap and cheerful place to sample great ‘moules and frites’ for under 15 Euros a time.
tourist centre and is enclosed in magnificent Baroque buildings. Worth a few hours sipping a hot chocolate while watching
Bruges, which egotistically has dubbed itself the ‘Venice of Northern Europe’ is only an hour by train. 3 million people mob this tiny town of 100,000 every year scoffing the ‘moules et frites’ and sipping on Belgian beers. Nice place for some food, some walking but boring after dark. If you’re looking for some proper nightlife Antwerp is the place where you’ll find the locals. 90 minutes away it’s also a good spot for some hardcore shopping away from the tourist traps of Brussels and Bruges. Find the full Brussels guide at JuniorDr.com
Key attractions
Manneken-Pis
Manneken-Pis - This literally takes the piss! Belgium’s most popular tourist attraction is a tiny bronze statue of a boy peeing. Nobody really knows what he symbolises or why he’s there. More interesting is why the scores of tourists crowded around stare for so long. Grand Place - This is the
Key facts • Population - 2,090,000 • Language - French (85%) and Flemish • Currency - Euro • Belgium produces 172,000 tons of chocolate a year. • World defining ideas from Belgium include the Smurfs, waffles and ‘french fries’.
17
Across:
2 Score for severity of pneumonia; where the pavement meets the road (4) 8 Hospital-acquired (10) 10 His capsule encloses the glomerulus (6) 11 Mobitz type I AV block (10) 13 Syndrome of trisomy 18 (7) 14 Enzymelinked immunosorbent assay (5) 16 Test for folic acid/vitamin B12 deficiency; rhymes with an eskimo’s home (5) 17 Sputum for the layman (6) 18 Lifelong protozoan infection; feline primary hosts (13) 19 Large bloodsucking fly of tropical Africa, can transmit parasites for sleeping sickness (6) Down:
1 Classification system to define spread of ovarian, uterine and cervical cancers (4) 3 Traditional ghost’s greeting of choice; bladder outflow obstruction (3) 4 Benign tumour composed of blood or lymph vessels (7) 5 Very rare mental condition in which the individual believes they are a wolf (11) 6 Type of hernia that involves bowel wall only - not lumen (8) 7 Dark chocolate in red wrapping; neurologist associated with tuberous sclerosis (11) 9 Genus of yeasts that inhabit the vagina and alimentary tract (7) 12 Crackling sound/grating feeling when bone rubs on bone or roughened cartilage (8) 13 Supercilium;
You can find the answers by searching for ‘crossword answers’ at www.juniordr.com
can be waxed or threaded (7) 15 Bile containing (7)
Compiled by Farhana Mann
Medical Report Assessed by Gil Myers
C
learly Mr Simpson exhibits a number of poor lifestyle choices that are having a detrimental effect on his health. His excessive eating, drinking and lack of exercise have resulted in obesity. Mr Simpson also continues to put himself in situations which could result in sustained traumatic head injuries. Without further brain imaging it would be difficult to estimate the extent of this damage. However, it would be remiss not to look beyond the (rather large) surface and think about some of the other possible conditions that Mr Simpson could be suffering from.
Radiation Poisoning Mr Simpson’s hair loss, pronounced skin darkening (around the face and neck) and fatigue could be the effect of chronic exposure to dangerously high levels of radiation. This may be in part due to his own carelessness or because of poor safety control at Mr Burn’s nuclear power plant. Excessive exposure to ionising radiation can cause damage to organ tissue which the body cannot repair. Most symptoms appear after around 15 years - Mr Simpson started work in late 1980s.
Congenital hepatic fibrosis Mr Simpson is yellow. His father is yellow. His wife is also yellow, as are his children. This is suggestive of a genetic condition that is inherited in an autosomal recessive pattern. CHF is such 18
HOSPITAL MESS
MR HOMER SIMPSON a disease and the end result is that jaundice is widespread in the Simpson family. Bart, Lisa and Maggie should consider having their future partners genetically screened to avoid passing this on to further generations - or at least attempting to date someone who isn’t yellow.
Kleine-Levin Syndrome A rare disorder which is characterised by hypersomnia - excessive amounts of sleep, sometimes over 20 hours/day - and compulsive hyperphagia - which can be indiscriminate in its nature and takes in all food sorts. Patients may also show an abnormally uninhibited sexual drive resulting in attempts to perform acts without due care and attention to discovery - for example the Springfield crazy golf course. There is only symptomatic treatment.
Intermittent explosive disorder IED is a behavioural disorder characterised by extreme expressions of anger, often to the point of uncontrollable rage that are disproportionate to the situation at hand. On several occasions Mr Simpson has been reported to have been attempting to ‘throttle Bart’ with only the flimsiest of reasons. He was also smiling. While I am in no doubt that this is learned behaviour there does appear to be an inability to resist resorting to these actions - sometimes more than once in a 30 minute episode.
Writing in the Notes esentative
Colleges unrepr
by the collegDear Editor, e recent backlash th g in t ad re en be I’ve urs from Augus reduction in ho D T n ca I EW e ). th es over ’ Iss 12 p6 as hours slashed ning may take (‘Patients at risk at ncerns th trai co r ei th nd ta represent many unders ey are failing to th el fe I t bu ng hours. They longer ion in my worki ct du re a t an w e lorry drivers of us. I a reason - just lik r fo d ce du re g should surgeons are bein retches neither st ng lo r fo e iv level there is can’t dr n a more selfish O e. at er op to ople, apart from be able pect too. Few pe as e lif of ity al , are supporting the qu this rare occasion on l t en m rn ve representing al the go lleges should be co e th ly re Su that. embers? views of their m
Name witheld Medicine neral Ge 2 ST
Keep our trained
W
hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
Ham sandwich (white bread no salad)
Dr J Aggrawal Surgery
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My Cardiology Id
agazine colDear Editor, has her own m R Sp gy lo io rd a superstar Your ca lead the life of es do y nl ai rt ce catching a umn and nd skiing before ke ee w a r fo is the tedi- jetting off tant job. Where ul ns co r he rm mindnumbcab to confi s meetings and es dl en , ns io at P but she is um of dict iet career as a G qu a se oo ch I s? r diaries isn’t ing report and reading he ng ri bo em se e t time please making m self-esteem. Nex y m r fo rs de ne less excitdoing won and pick someo ur vo fa a us of do the rest atology SpR. ing - like a derm Elaine Cardess h Thames GP SpR, Nort
‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.
£1.19
Newham General Hospital
It’s too expensive to pig out at:
£2.95 Evian water 50cl
doctors here
Dear Editor, I welcome the expansion of th e Medical Traini Initiative that al ng lows overseas do ctors to benefit training in the from UK (‘750 UK training placem for overseas do ents ctors’ Iss 12 p5 ). However, I w like to point ou ould t that overseas doctors who st at medical scho udied ol in the UK ar e being forced to because of chan leave ges to the visa system. Not on many people fe ly do el this is unfair as the goalpost been moved in s have the last few year s but the UK is ing doctors that losthey paid to tr ain. I would su that this situat ggest ion deserves ur gent attention Department of by the Health.
Surely pork is worth more at:
Royal Free Hospital, London
It’s cheaper to stay well hydrated at:
70p
Belfast City Hospital
So expensive you’ll wet yourself at:
95p Sachet of tomato ketchup
Royal Free Hospital
Squeezilicious at:
£Free
St Bartholomew’s Hospital, London
Bet it goes all over your shirt too at:
10p
QE2 Hospital, Welwyn Garden City
Next issue we’re checking the cost of a packet of ready salted crisps, small hot chocolate (takeaway) and an apple. Email prices to hospitalconfidential@juniordr.com.
Colchester General Hospital Colchester doctor’s mess has a flatscreen TV with Sky, microwave, dishwasher, and coffee maker. Off the main mess is a room with three computers. The usual tea, coffee, toast and cereals are provided along with daily newspapers. One plus is having a cleaner. Mess fees are £10 a month with occasional subsidised mess nights out.
JuniorDr Score: ★★★✩✩
HOSPITAL MESS
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